How ERISA helps -- and complicates -- your disability claim

If you are fortunate to have retirement benefits through your employer, you may be aware of the Employee Retirement Income Security Act of 1974. ERISA provides strict guidelines for private employers who offer such benefits to ensure that the trustees of retirement plans behave ethically with your money.

What you may not know is that ERISA also regulates health and disability plans private employers provide. Because ERISA is complex and rigidly regulated, you would benefit from understanding how the law protects your rights, especially if you have recently suffered a debilitating illness or injury.

ERISA protection

One of the main goals of ERISA is to ensure that workers like you understand the benefits your employer offers. In this way, the law protects you from an employer who decides to change your benefits without informing you, perhaps leaving you without the coverage you thought you had. Therefore, if your private employer offers disability insurance coverage, ERISA requires him or her to notify you of the following information:

  • What the insurance plan does and does not cover
  • How to file a disability claim
  • How the appeals process works for denied claims

If you file a claim, the insurance provider has a limited amount of time to respond. Denial of a claim requires the insurance company to inform you in writing and explain the reasons for their refusal to cover your claim. You will have a deadline to file an appeal with the insurance company.

Dealing with denial

If the insurance provider denies your appeal, your options are not exhausted. You can file a lawsuit during which a South Carolina judge will consider the steps you have already taken and decide if the insurance company wrongly denied your benefits. The judge will base his or her decision solely on your case file that the insurance company will submit.

Your case file will include all the documentation related to your claim, including medical reports and letters from your employer. If you haven't provided much documentation, the judge will have no choice but to make a decision based on the insurer's denial.

Seeking assistance for best results

The process for claiming disability coverage through your employer's benefits package is complicated and confusing, and ERISA strictly enforces the deadlines and regulations. If you miss a deadline for filing a claim or appeal, or if you miss a step in the process, you may lose your chance to claim coverage or to appeal.

If you are disabled, you are probably counting on the benefits provided through your employer's insurance. To maximize your chances of completing the process correctly and in a timely manner, you would benefit from the assistance of an attorney who can help you navigate the difficult world of ERISA regulations.

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